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Neurol Clin. 2017 May;35(2):295-323. doi: 10.1016/j.ncl.2017.01.007.

Vascular Contributions to Cognitive Impairment in Late Life.

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Department of Neurology, University of Southern California, 1540 Alcazar Street, CHP215, Los Angeles, CA 90033, USA. Electronic address:
Department of Neurology, University of California San Francisco, 400 Parnassus Avenue, A871, San Francisco, CA 94143, USA.


Cerebrovascular disease (CVD) is the second leading cause of cognitive impairment in late life. Structural neuroimaging offers the most sensitive and specific biomarkers for hemorrhages and infarcts, but there are significant limitations in its ability to detect microvascular disease, microinfarcts, dynamic changes in the blood-brain barrier, and preclinical cerebrovascular disease. Autopsy studies disclose the common co-occurrence of vascular and neurodegenerative conditions, suggesting that in late life, a multifactorial approach to cognitive impairment may be more appropriate than traditional dichotomous classifications. Management of vascular risk factors remains a proven and practical approach to reducing acute and progressive cognitive impairment and dementia.


Diagnosis; MRI; Neuropathology; Silent brain infarct; Treatment; Vascular cognitive impairment; Vascular dementia; White matter hyperintensity

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